宫腔镜辅助下分段诊刮术与单纯分段诊刮术诊断子宫内膜癌价值比较  

Comparison of hysteroscopy assisted dilatation and curettage and traditional dilatation and curettage in the diagnosis of endometrial carcinoma

作　　者：张晓勇[1] ZHANG Xiaoyong(Department of Obstetrics and Gynecology, the First Affiliated Hospital of Liaoning Medical University,Jinzhou 121000)

机构地区：[1]辽宁医学院附属第一医院妇产科

出　　处：《陕西医学杂志》2019年第8期1045-1048,共4页Shaanxi Medical Journal

摘　　要：目的:探讨宫腔镜辅助下分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值,及是否增加腹腔冲洗液细胞学阳性率。方法:回顾性分析病理检查确诊为子宫内膜癌患者168例的临床资料,分为宫腔镜分段诊刮组75例和单纯分段诊刮组93例,比较两组术前病理诊断子宫内膜癌的准确性、判断宫颈受累的可靠性及腹腔冲洗液细胞学的阳性率,并同时分析病灶面积、组织学分级、肌层浸润深度及组织学类型等与腹腔冲洗液细胞学的关系。结果:宫腔镜组术前病理诊断的准确率为96%(72/75),单纯诊刮组为84.9%(79/93),两组比较差异有统计学意义(P<0.05)。宫腔镜组宫颈受累诊断的敏感度、准确率、阳性预测值、阴性预测值分别为75%、97.3%、100%和92%;单纯诊刮组分别为56%、82.8%、73.7%和85.1%,两组比较差异均有统计学意义(P<0.05)。宫腔镜组腹腔冲洗液阳性率为18.67%(14/75),单纯诊刮组为18.27%(17/93),两组比较差异无统计学意义(P>0.05)。腹腔冲洗液细胞学阳性与宫腔病灶面积有关(P<0.05),与组织学分级、肌层浸润深度及组织学类型无关(P>0.05)。结论:宫腔镜下分段诊刮可提高术前子宫内膜癌的病理诊断准确率,可准确评估子宫内膜癌患者宫颈受累情况,并且不增加腹腔冲洗液阳性率。腹腔冲洗液阳性率与宫腔病灶面积有关。Objective:To explore the value of Hysteroscopy assisted dilatation and curettage in the diagnosis of endometrial Carcinoma and the relationship of diagnostic hysteroscopy and positive peritoneal cytology.Methods: A retrospective study was carried out on 168 cases of endometrial carcinoma.Among them,93 patients were diagnosed by dilatation and curettage,75 patients were diagnosed by hysteroscopy.The diagnostic veracity of pathologic diagnosis,the reliability in judging the cervical involvement and the rate of positive peritoneal cytology of the two methods are compared.The correlation of positive peritoneal cytology with tumor distribution in the uterine cavity,depth of myometrial invasion, differentiation grade and histology type were analyzed.Results:In group of hysteroscopy, 96%(72/75) of patients were Diagnosed pathologically before surgery;the rate was 84.9%(79/93) for group of traditional dilatation and curettage.The difference between the two groups was statistically significant(P<0.05).The sensitivity,accuracy,positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 75%,97.3%,100 % and 92% for group of hysteroscopy and 56%,82.8%,73.7% and 85.1 % for group of traditional dilatation and curettage respectively.The positive peritoneal cytology rate was 18.67 %(14/75) in group of hysteroscopy and 18.27%(17/93) in group of traditional dilatation and curettage.The difference was not statistically significant(P>0.05).The positive peritoneal cytology rate was significantly correlated with tumor distribution in the uterine cavity(P<0.05),but not correlated with depth of myometrial invasion, differentiation grade and histology type(P>0.05). Conclusion:Compared with hysteroscopy assisted dilatation and curettage and traditional dilatation and curettage offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients,but it did not increase the positive peritoneal cytology rate

关 键 词：子宫内膜癌 诊断 宫腔镜检查 分段诊刮 腹腔冲洗液 对比研究 

分 类 号：R737.33[医药卫生—肿瘤]